Search

Gastro-oesophageal reflux (GOR) is very common in the first year of life. A step-wise approach, firstly promoting conservative strategies, is advisable in uncomplicated cases. Milk thickening is a longstanding practice for the management of GOR. Infant formulas can be thickened at home or industrially with specific thickening agents (rice starch, cornstarch, cereals, locust bean gum) which increase their viscosity, thereby thwarting the passage of gastric content into the oesophagus. The efficacy of milk thickening to reduce typical reflux symptoms, like vomiting and regurgitations, has been largely reported in term-born infants; as a consequence of the lowered nutrient loss, an improved weight gain is frequently noticed. Even so, the effect of thickening practices on reflux features, detected by pH-monitoring or other diagnostic investigations, is still controversial. According to current guidelines, milk thickening is advisable in infants suffering from frequent regurgitations/vomiting and failure to thrive, without further clinical complications. With regard to safety issues, although in vitro researches cast some doubts on the nutritional adequacy of thickened formulas, results from in vivo studies are reassuring. Furthermore, while home-thickened formulas were reported to increase coughing episodes, to require greater sucking efforts and to provide higher caloric contents, current commercial anti- regurgitation formulas seem to be not associated with analogous side effects. Eventually, data from the preterm population are very few and do not support the effectiveness of milk thickening in improving reflux symptoms; moreover, noticeable adverse events, like a higher incidence of necrotizing enterocolitis, have been reported, thus entailing an unfavourable benefit-risk ratio.

BACKGROUND: Gastro-oesophageal reflux (GOR) is common in preterm infants; conservative interventions (i.e. dietary changes) should represent the first-line approach. AIM: To evaluate by combined pH and impedance monitoring (pH-MII) the effect of a new preterm formula thickened with amylopectin (TPF) on GOR features in symptomatic preterm infants. METHODS: Twenty-eight symptomatic preterm newborns underwent a 24-hour pH-MII; each baby received eight meals (four of TPF and four of a preterm formula [PF]). GOR indexes (number, acidity, duration and height of GORs) after TPF and PF meals were compared by Wilcoxon Signed Ranks Test. Viscosity of PF and TPF was measured. RESULTS: TPF significantly decreased the number of acid GORs detected by pH-monitoring (TPF vs. PF: median 20 vs. 24.5, p = 0.009), while it had no influence on Reflux Index (RIpH), nor on acid and non-acid GOR indexes detected by MII, GOR physical features, and GOR height. TPF's viscosity was extremely higher than PF's, and further increased at pH 3 after the addition of pepsin. CONCLUSIONS: The new formula was found to reduce the number of acid GORs detected by pH-monitoring; it did not reduce neither total oesophageal acid exposure nor non-acid GORs. At present its extended clinical use cannot be recommended.